显微手术治疗三叉神经鞘瘤

Microsurgical treatment of the trigeminal neurinomas

目的总结各种类型三叉神经鞘瘤手术入路的优缺点。方法回顾分析１９８０年４月～１９９７年６月手术治疗的３４例三叉神经鞘瘤的临床效果。结果肿瘤完全位于中颅窝的３例，均采用颞下入路切除，肿瘤位于后颅窝的１３例，１０例经枕下入路，２例采用颞下经小脑幕入路，１例经乙状窦前入路切除。另１８例哑铃型肿瘤中１４例采用颞下经小脑幕入路，４例采用经颞下－乙状窦前入路切除。结论颞下入路适用中颅窝型肿瘤切除，枕下入路适合后颅窝型肿瘤切除，哑铃型肿瘤可用颞下经小脑幕入路或经颞下－乙状窦前入路切除，后者显露范围充分。

Objective The surgical approach of trigeminal neurinomas was studied and summarized in order to increase the rate of one staged total resection of those tumours Methods Thirty four patients with trigeminal neurinoma operated on in our hospital through April 1980 to June 1997 were analyzed retrospectively Results All tumours in this group were divided into three types Type A(3 cases),which predominantly located in the middle fossa,was operated on via subtemporal approach Type B(13 cases),which predominantly located in the posterior fossa,was operated on through suboccipital craniotomy in 10 cases,subtemporal transtentorial approach in 2 cases and presigmoid approach in 1 cases Type C(18 cases),which was called dumbbell shaped tumour extending into both the middle and posterior fossa,was operated on via subtemporal transtentorial approach in 14 cases and subtemporal presigmoid route in 4 cases One staged total removal of tumours was achieved in all cases but one Conclusion Subtemporal approach is appropriate for type A tumours,suboccipital craniotomy for type B tumours and subtemporal transtentorial or subtemporal presigmoid approach for type C tumours Subtemporal presigmiod approach is especially suitable for dumbbell shaped tumours predominant in posterior fossa due to its broad exposurs